Vonoprazan High-Dose Dual VS Levofloxacin Concomitant

Inclusion Criteria: * Age ≥ 18 years and ≤ 80 years (adjust upper limit as needed) * Confirmed Helicobacter pylori infection by at least one of the following: positive urea breath test, rapid urease test, histopathology, or stool antigen test * Treatment-naïve for H. pylori (no prior eradication therapy) - OR - prior treatment failure (specify if rescue therapy) * Willing and able to provide written informed consent * Willing to adhere to the 14-day treatment regimen and follow-up visits * For women of childbearing potential: negative pregnancy test and agreement to use effective contraception during the treatment period Exclusion Criteria: * History of allergy or hypersensitivity to vonoprazan, amoxicillin, clarithromycin, metronidazole, or any other penicillin/cephalosporin * Previous H. pylori eradication therapy (if study is for first-line treatment) * Active gastrointestinal bleeding or perforation * Severe liver disease (Child-Pugh class B or C) or severe renal impairment (eGFR \< 30 mL/min/1.73m²) * Pregnancy or breastfeeding * Concurrent use of medications with significant drug-drug interactions (e.g., warfarin, phenytoin, digoxin, atazanavir, rilpivirine) * Malignancy or any life-threatening condition with life expectancy \< 6 months * Participation in another interventional trial within 30 days prior to enrollment * Any condition that, in the investigator's opinion, precludes safe participation or adherence to the protocol